Women are now well established in medicine, but historically this
was not always true. Hence, it seems reasonable for each specialty to
analyze itself from time to time to determine where it stands on the
inclusion of women in practice and in leadership positions. While
otolaryngology-head and neck surgery has generally been considered a
woman-friendly surgical subspecialty, we, too, should assess our field
to be certain that we are doing as well as we might think we are.

In 2010, the Association of American Medical Colleges (AAMC)
reported that nearly 40% of physicians in the United States were women;
28% of accepted medical school applicants and 49% of graduating medical
students were women? Those figures represent substantial progress. For
example, only 9% of accepted applicants and 7% of graduates in 1965 were
female. (1) As of July 2010, 1,346 women in otolaryngology were active
members of the American Academy of Otolaryngology-Head and Neck Surgery
(AAO-HNS), representing 12.4% of the membership. (2) As of March 2011,
1,724 out of 11,868 (14.5%) members of the AAO-HNS were women (with 220
members unidentified by gender). (3)

AAMC data show that two-thirds of women physicians practice in six
specialties) One is anesthesiology; the other five rank among the
lowest-paying specialties in medicine (family practice, internal
medicine, obstetrics and gynecology, pediatrics, and psychiatry). The
reasons for this disproportionate distribution are uncertain. While some
of these fields have shorter residencies (if fellowships are excluded)
than some of the surgical fields, the old argument about better
lifestyles is certainly open to challenge, as anyone who has taken call
in obstetrics or pediatrics knows well.

Additional AAMC data indicate that women have been pursuing
residencies in other fields with increasing frequency: Over the past
decade, 22% of urology residents have been women, and 13% each of
orthopedic surgery and thoracic surgery residency positions were held by
women. (1)

I made multiple attempts to determine what percentage of applicants
to otolaryngology residency programs are women and what percentage of
accepted residents are women, but this information is not available
through AAO-HNS, the American Board of Otolaryngology, the Association
of Academic Departments of Otolaryngology-Head and Neck Surgery, or
numerous other sources.

Women surgeons have taken various approaches to involvement in
organized medicine. The board of directors of AAO-HNS established a
section on Women in Otolaryngology (WIO). Interestingly, female
otolaryngologists organized their efforts within the Academy rather than
separately. This makes Otolaryngology-HNS the only surgical subspecialty
that does not have a women's organization established outside the
subspecialty's academy, rather than within the traditional
organization. WIO has already become a valuable influence within the
AAO-HNS and the field of otolaryngology.

Nationally, women have become more prominent in leadership
positions in the past decade. According to the AAMC, between 2003 and
2008, the number of women associate and vice-chairs increased by 73%
(all fields of medicine), and the number of women division chiefs more
than doubled. (1) There are female deans at 16 U.S. medical schools
(12%). (1) The first woman medical school dean in the United States was
Leah Lowenstein, who was appointed to the position at Jefferson Medical
College, Thomas Jefferson University, in 1982.

For the purposes of this editorial, I surveyed many of the major
otolaryngology journals to determine the number of women who serve as
their editors and on their editorial boards. Of all the journals
surveyed, only the Journal of the Association for Research in
Otolaryngology has a woman as its editor; the Journal of
Otolaryngology-Head and Neck Surgery has a man and a woman as coeditors,
and the rest have men as editors.

The number of women, total number of members, and percentages of
women on editorial boards are as follows: *

* Acta Oto-Laryngologica: 11 of 100 (11%)

* American Journal of Otolaryngology-Head and Neck Medicine and
Surgery: 10 of 54 (18.5%)

* American Journal of Rhinology & Allergy: 4 of 36 (11%)

* Annals of Otology, Rhinology & Laryngology: 9 of 51 (17.6%)

* Archives of Otolaryngology-Head 6. Neck Surgery: 5 of 28 (17.9%)

* Ear, Nose & Throat Journal: 23 of 160 (14.4%)

* European Archives of Oto-Rhino-Laryngology: 3 of 54 (5.6%)

* Head & Neck: 15 of 89 (16.9%)

* Journal of the Association for Research in Otolaryngology: 6 of
15 (40%)

* I received no response from Folia Phoniatrica et Logopaedica and
The International Tinnitus Journal.

Despite these advances, there are still discrepancies between male
and female medical professionals. One important issue is reimbursement.
For example, Lo Sasso et al evaluated New York data from 1999 through
2008 and discovered that newly trained male residents earned a mean of
$16,819 more than female residents in 2008, compared with a difference
of $3,600 in 1999. (4) The gender gap extended across specialties,
practice types, and locations. According to the authors, it could not be
explained by the number of hours worked.

Unfortunately, otolaryngology is no exception to this disparity. In
2008, the mean starting salary for male otolaryngologists (who
represented 1.4% of all physicians starting practice in the United
States) was $207,329. (4) Female otolaryngologists (0.4% of all
physicians) started with a mean salary of $175,122. (4) This is a
difference of about 15.5%. Having read the literature, I am unable to
discern a reason for the gender gap in compensation in our field, or in
other fields. It has been suggested that "female physicians may be
seeking out employment arrangements that compensate them in other,
nonfinancial ways, and more employers may be beginning to offer such
arrangements." (4)

While it is possible (as has been speculated) that women are
earning less money by choice in order to have more flexible lifestyles,
minimize unpredictable weekend on-call commitments, etc., I am not aware
of any data investigating those possibilities, let alone confirming
them. I believe it is dangerous for us to make that assumption. Along
with the rest of medicine, otolaryngology should study this important
issue to be certain that gender bias has been eliminated from our
specialty.